Nature Prescriptions? Just What the Doctor Ordered

Prescribe Outside, a partnership between Children’s Hospital of Philadelphia (CHOP) and Awbury Arboretum, hosts frequent events that get kids, their families, and their doctors in nature together. / Photography courtesy of Children’s Hospital of Philadelphia

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On a recent Saturday afternoon, a dozen children and their families gather outside Children’s Hospital of Philadelphia’s (CHOP) Cobbs Creek office. The kids are all ages — from infants to young teens and many play hopscotch, blow and chase bubbles, and draw colorful chalk images on the sidewalk.

This isn’t a block party, birthday celebration, or ribbon-cutting event for a new CHOP endeavor. Instead, the agenda for today is simple, yet rooted in community health: Go on a hike … with doctors.

This is Walk with CHOP, a monthly event that brings families and hospital staff together to spend time in nature. It’s part of a larger CHOP initiative called Prescribe Outside, a program launched in 2022 in partnership with Awbury Arboretum to improve children’s physical and mental health by getting kids out of the house and into their environment. (The program also teams up with Let’s Go Outdoors, a community group focused on helping people spend time in nature; Temple University’s Center for Sustainable Communities; the Sierra Club; and the U.S. Department of Agriculture, Forest Service.)

The belief is that nature can and should be prescribed — yes, CHOP doctors are ordering scripts for the great outdoors — as it’s a natural (ahem) health booster. Studies have found that being outside can improve memory, reduce stress and help combat depression. No wonder we instinctively reach for nature when our bodies feel off-kilter — breathing in salty ocean air when we’re congested, for example, or taking a walk to clear our heads. (In Japan, the tendency has been formalized in the practice of “forest bathing” — slow, mindful, restorative walks in the woods, which have become mainstream in the U.S.)

Now, health systems around the world are going a step further by medically advising patients to spend more time outside. There’s Park Rx, a Washington state-based program similar to CHOP’s. And across the pond, the U.K.’s National Health System runs a Dose of Nature program, which has a 64 percent recovery rate for people struggling with mental illness who use the program.

Earlier this month, CHOP expanded its program by hiring its first nature prescription coordinator, Julianna Berardi, who acts as a kind of liaison between providers, families, and Mother Nature. Under her direction, kids and their families schedule time outside into their routines — similar to how they would, say, take a daily vitamin — and create plans that are, according to her, accessible, achievable, and family-centered.

On this Saturday afternoon, I’m participating in CHOP’s monthly hike to see how the program’s nature prescriptions are “filled.” From CHOP’s Cobbs Creek office, we head across the street to Cobbs Creek Trail, a 4.2-mile path that runs alongside the park’s creek. Though we’re only steps away from a four-lane thoroughfare, it’s nonetheless quiet in this stretch of woods. Birds chirp, I can hear the gentle runnel of the creek, and we’re surrounded by trees and blooming flowers.

CHOP patients, families, and staff participating on April’s Walk with CHOP event

Grace Parker, Prescribe Outside’s project manager, leads the children in collecting flowers of varying shades. I’m delighted to watch the kids race to a grove of violet blooms that they’ll later attach to drawings of rainbows they’ve created, bringing life to their own art. When we reach the creek, Parker sets up rain drums so the kids can pour cups of water over them. The water’s tinkling, chime-like sounds are soothing and melodic, and I imagine the others are feeling the same sense of respite from honking cars and the hustle of city streets as I am.

So, how does one get “prescribed” nature? In CHOP’s program, doctors identify whether a child might be a good fit for a nature prescription during well visits. They ask patients about what they do after school, what brings them joy, what they do to keep active, and about their mental health. They use a holistic approach to determine whether the children might need more time outside.

If so, families can work with their doctor to create a plan, or meet with Berardi at her office in the Karabots Pediatric Primary Care Center in West Philly. She helps families identify times they can realistically get outside, as well as activities that are a good fit for their child’s interests — like walking in a community park or playing soccer with neighbors.

So far, over 1,300 people have participated in Prescribe Outside, with events ranging from hikes to outdoor yoga to tours of Awbury Arboretum’s farm. More than 50 providers across six CHOP locations have written nature prescriptions, but families can also come to the free events without a doctor’s official instruction.

For West Philly residents Vince and Imani Gumbs, Prescribe Outside has provided an opportunity for their family to explore their neighborhood and meet more members of their community. They have three kids — ages five, two, and just under a year — and are plenty active. (Before the hike, their son had T-ball practice and their daughter had gymnastics.) But they wanted to find ways to get outside more casually. When Imani saw the flyer for Prescribe Outside during a doctor’s appointment, she thought, “Why not give it a shot?” It didn’t hurt that this year’s Walk with CHOP events are Bluey-themed. Her kids, she says, are obsessed with the show.

“Having a designated time to come out with other people is motivating,” she says as we walk the trail. “I love seeing our doctors out here with us. Plus, our son is homeschooled, so for him to be able to come out with other kids his age and have this experience — I love that.”

Vince admits that he didn’t know the Cobbs Creek Trail existed before participating in Prescribe Outside’s programs, even though he grew up in West Philly and his family currently lives three minutes from the path. Parker, our fearless hiking guide, says she and other Prescribe Outside folks hear this often from families — that they didn’t know about parks and other green spaces in their own neighborhoods prior to coming to an event.

“It’s broadening our awareness of what’s available in our neighborhood,” says Vince.

One of the hike attendees, feeling confident on the trail

Prescribe Outside’s hikes are also open to hospital staff. (During the one I attended, a NICU nurse and a surgical trauma nurse volunteered to help facilitate the activities.) The goal, Parker says, is to help medical professionals reap some of the same benefits — improved mental health, and reduced stress and anxiety — that their patients are experiencing. This is especially important, as many medical care providers are struggling with burnout right now.

“It’s zen for me to be outdoors. I hate being cooped up,” says Sharon Sutherland, a pediatrician at CHOP Primary Care, Cobbs Creek, who helped create the Prescribe Outside program. “We know the importance of being outdoors and the health benefits,” which is why she’s brought her two kids to the hike.

There’s also a shared benefit: Bringing patients and doctors together for activities that aren’t directly related to the hospital can help build stronger relationships between patients and their healthcare providers.

“You get to know them,” Sutherland says of walking with her patients, “and they get to know their doctors. They see my family jumping in the water, jumping in the mud, and it normalizes [us] and the experience.”

As Berardi, in her new role, begins to work closely with families to develop plans to fulfill their nature prescriptions, CHOP’s doctors are looking to protect access to the great outdoors. There are a lot of parks and green spaces in Philly — they know because they’ve mapped it — but too often, our parks are filled with litter, and our rivers are dirty. Unclean and unsafe environments are one of the biggest hurdles Prescribe Outside programmers have seen families face when trying to fill nature prescriptions.

That’s why CHOP docs have been advocating for a Children’s Outdoor Bill of Rights, a commitment to preserving clean air, safe parks, water access and other environmental protections to ensure that more kids have healthy, safe outdoor environments. Governor Josh Shapiro and Lieutenant Governor Austin Davis endorsed the framework last October.

“We’re trying to find something that brings kids joy, something that isn’t electronic,” says Barbara Rolnick, a pediatrician at CHOP Primary Care, Roxborough, who helped create the Prescribe Outside program. “Children deserve to have access to clean water, clean air, and safe places to play outdoors. We are excited to bring [that] to all children in Pennsylvania.”

Our hike ends at Cobbs Creek Park’s Nature Playground, a climbing space made from tree stumps and natural wood. The kids chase their new friends around, laughing. One takes out his drum and begins to play, shouting, “I’m making music for the birds.” Everyone — especially the kids — seems filled with a little extra joy.

And no one wants to go back inside.

Prescribe Outside has a number of upcoming events in various neighborhoods. You can find the full list here.